Decarbonising allied to healthy design principles

As numerous research and academic studies have shown, and indeed practical experience in hospitals and other healthcare facilities have demonstrated, well-designed buildings are key to the provision of quality healthcare. This is a subject that has formed the centrepiece of many pieces of academic research, with the Design Council’s Future Health: Sustainable Places for Health and Wellbeing report among a raft of published documents highlighting the impact of building design on occupant performance in this sector.</Intro><Text>The importance of good healthcare facilities was brought into sharper focus than ever before during the pandemic, with a number of specialist buildings created to help bring effective care to COVID-19 patients. Perhaps the most well-known example were the emergency Nightingale Hospitals, which were constructed in London, Birmingham, Manchester, Bristol, Exeter, Sunderland, Belfast, and Harrogate.

Pressure to decarbonise

Added to the many different considerations for those involved in designing healthcare buildings is the growing pressure to decarbonise the built environment in the face of fast-approaching Net Zero targets. Given that the healthcare sector accounts for around 4.6% of global carbon emissions, the onus is on the sector to play its part in this transition, and – against this backdrop – there has never been a more pertinent time to ensure that healthcare facilities are ‘healthy by design’, both in terms of occupant wellbeing and environmental impact.

Market challenges

In short, the concept of ‘healthy by design’ is to ensure that facilities are constructed with current and future challenges in mind. While occupant wellbeing and sustainability appear to be the headline issues here, there are a number of wider considerations that health estate designers must take into account. Primarily, buildings constructed for NHS usage must adhere to strict safety standards. While some guidance on best practice is provided through the Department of Health and Social Care’s Health Building Notes, there is no indication as to how this should be achieved.

Alongside the construction of new buildings, designers must also contest with rapidly ageing building stock. The extent of this challenge was highlighted by data released in 2018-19, detailing a £6.8 bn maintenance backlog, of which £3.4 bn related to issues that presented a ‘high or significant risk to patients and staff’. This challenge has been exacerbated by the UK’s ageing population, with both men and women now living longer than ever, placing increased stress on public healthcare facilities.

In an effort to address these concerns, the then government pledged £3.7 bn for the construction of 40 new hospitals by 2030. This presents a significant opportunity to install healthy design principles going forward to ensure that these are not recurring challenges.

Gauging attitudes

With so many factors to consider, it is important to assess what health estate designers currently consider to be priorities for building design. For this reason, Rehau conducted a survey of 520 M&amp;E designers and architects as part of its Designing Healthy series, which also encompasses apartments, hotels, and educational buildings. Of the 520 surveyed, 25% worked primarily in healthcare.

Unsurprisingly, sustainability received top billing when contractors were queried on their top priorities when specifying building materials. However, this was shortly followed by cost, highlighting another challenge that building designers are currently faced with. A notable 44% of respondents believed that wellbeing is ‘often’ value-engineered out of a building’s design at a later stage, while a further 32% stated that this is ‘always’ the case. Despite this, 98% were willing to pay for a product that had a longer expected lifespan. With this in mind, it is clear that the adoption of robust, long-lasting healthy design features is necessary to ensure that cost-cutting measures do not compromise on occupant wellbeing and sustainability further down the line.

Offsite construction 

A good starting point for healthy building design is the construction process itself. Here, there may be a case for offsite construction to become the new industry standard – in the interests of both sustainability and patient and staff wellbeing. Offsite construction has often been proven to be faster than its on-site counterpart, leading to lower embodied emissions for the build, and limiting noise pollution that would otherwise prove disruptive to building occupants. Moreover, this can also help to deliver better quality control and lower costs for the build. Together, these factors make a strong case for this technique. Returning to Rehau’s survey, 58% also believed that demand for offsite construction methods will increase in the light of the recent pandemic, highlighting that it may be time to explore new approaches to construction in healthcare environments.

District heating

A significant portion of energy demand in the healthcare sector is attributable to the heating and cooling of the facility itself. For this reason, adopting greener methods of heat provision will prove key to falling in line with Net Zero targets. One such technology that aligns with this goal is district heating, wherein a singular heat source provides heat and hot water for multiple buildings through a shared network rather than individually, leading to carbon savings.

The Government has recently demonstrated ample support for this technology – through such schemes as the £338 m Heat Network Transformation Programme, and £288 m Green Heat Network Fund, which are set to help drive uptake. Unsurprisingly, 70% of respondents to Rehau’s survey believe that demand for district heating systems is set to increase in the next five years in line with this. However, it is important to recognise that not all heat networks are created equal. The systems most commonly observed in the UK at present are third generation, supplying water at 70-90 °C, with a gas combined heat and power (CHP) system as the heat source. The true potential for carbon savings comes in the form of fourth generation networks, which circulate water at 40-60 °C – for lower heat losses and greater carbon savings. Moreover, this technology also synergises well with a number of low-carbon heat sources, such as heat pumps, solar thermal systems, and even waste heat recovery systems from nearby data centres.

Pipe network buried underground

District heating networks distribute heat and hot water via a network of steel or polymer pre-insulated pipes that are buried under the ground. It should be noted that the lower temperature of fourth generation systems makes them better suited to polymer solutions, such as Rehau’s RAUVITHERM and RAUTHERMEX, as opposed to steel.

Acoustic performance

A key sticking point for occupant wellbeing in healthcare facilities is acoustics – the importance of which was recognised by respondents to Rehau’s survey, with 91% citing that it was either ‘important’ or ‘very important’. Research from King’s College London may offer an explanation for these results, indicating that noise levels in intensive care units regularly exceed 100 decibels. Meanwhile, another survey found that 40% of inpatients were unhappy with the level of noise on their ward. While it would be fair to assume that most of this noise stems from general hospital activity, this re-emphasises the need to minimise sound from controllable sources – such as building services – where possible.

A prime example of noise from building services is the disposal of wastewater as it passes through soil and waste pipework, which can be disruptive to those situated in nearby rooms. Here, solutions such as Rehau’s RAUPIANO PLUS offer 17dB(A) performance at flow rates of 4 litres/sec to virtually eliminate sounds of running water or vibrations, in order to maximise comfort for building occupants.

Drinking water

Another factor pertinent to occupant wellbeing is the provision of safe drinking water. Naturally, avoiding contamination from both internal and external sources is paramount to upholding the health of patients and staff. At present, the most commonly specified materials for the installation of heating and water pipes are copper and steel, given that metal is the traditional material of choice for this application. When queried on their reasons for specifying these metals, the respondents to Rehau’s survey cited ‘fewer tools’, and ‘more hygienic’, as the primary factors behind this.

However, there are a number of arguments to suggest that copper and steel are no longer the best materials for the provision of drinking water. Despite hygiene being cited as a key reason for the specification of metal pipework, copper and steel are more prone to microbial contamination than other solutions such as polymer and multilayer composite pipe (MLCP). 

This is especially important given that 83% claimed that they still specified fittings containing lead, which can leach into drinking water supply if pipework is not properly maintained. While this is already a general concern, it is particularly critical when caring for the vulnerable. Moreover, 42% said they were ‘often’ victims of copper theft, further highlighting the possible risks of specifying this material.

Scope for MLCP

Here, there may be scope for MLCP to prove an effective successor to metal pipework. Solutions such as Rehau’s RAUTITAN use RX+ lead-free fittings, meaning there is no risk of this harmful contaminant leaching into the water supply. RAUTITAN is also able to form a comprehensive watertight seal without an O-ring, which is a common point of failure in traditional pipework. Combined with vastly improved installation times, this means that MLCP is truly a fit-and-forget solution ideally suited to the needs of modern care facilities.

Closing thoughts

Future-proofing the nation’s healthcare estates against a multitude of factors is no mean feat. Sustainability, cost-effectiveness, ageing infrastructure, and a growing user base, must now be factored into the agenda, all without compromising on the health and wellbeing of patients and staff. Rehau’s report has revealed how these concerns weigh up against one another for those involved in the design of hospitals and other healthcare facilities, with sustainability currently the key driving force in this field. By examining innovative approaches to construction, heating, acoustics, and the provision of drinking water, contractors can help create facilities that simultaneously remain considerate to the environment, and uphold the wellbeing of their occupants despite a flurry of wider challenges. 

These areas offer only a glimpse into some of the incremental changes architects can incorporate towards achieving truly healthy building design, with this concept only limited by the scope of the designer’s imagination. It is through the application of these principles that facilities will be equipped to fulfil the demands of the future.

To download Rehau’s full report, Designing Healthy Healthcare, visit https://www.rehau.com/uk-en/designing-healthy-healthcare-download